Traditionally, academic medicine is a culture of individuals—rock-star researchers and surgeons developing novel techniques. Fee-for-service feeds this model, because once your part is done, you just move on to the next. It's like a track team, where it's great if we all win, but mainly we're focused on our individual events.
In contrast, value-based care requires us to work more like a football team. Each person has a position, but the team plays as a whole. Individuals don't win or lose, the team does. No quarterback throws a pass and says, 'I'm done, now it's your game.' Rather, he is completely invested in the result of that pass, and in every other play.
In academic medicine, we'll always have star players. But with bundled payments, they need to be quarterbacks, not decathletes.
Consequently, bundled payments are creating a culture change, and I believe it's for the better. They increase quality, decrease costs, encourage transparency and improve the overall patient experience—creating a win-win situation for everyone. Contrary to the common perception, specialists have a lot to gain through bundled payments.
That's why at Keck Medicine of USC, despite a high case mix index of nearly 3.0, we're all-in on bundled payments. This is not a common practice for institutions with a high CMI like ours, but it's working for us. We're part of a national bundled-payment program for knee, hip and spine procedures that in the past year has led to a 22% reduction in hospital readmissions for joint replacement surgeries and 17% fewer complications.
We're betting that our evolving team culture will have what it takes to win, for us and our patients.
But cheerleading and team rallies will not turn individuals into true team players. Instead, we have to change the game entirely.
This means rethinking our conventional methods and setting new processes and ways of working. We have to break down the fee-for-service bureaucracies as well as the individual player mindset. And if you're going to do that in one area, as required by Medicare for hip and knee procedures, it's best if you do it everywhere. We've started seeking out value-based contracts with self-funded employer groups in order to expand those opportunities.
As CEO, my job is to clear out the noise in the system, to break the culture of no. We have to remedy the system to make it work for doctors/clinicians and patients. My mantra: Always yes, always now. The way our systems operate can wear out our providers as much as any difficult case.
Data can be a catalyst for improvements. Doctors are excellent problem-solvers. Give them the information and they'll figure out what needs to change. Collectively as a team, our physicians are changing processes at Keck Medicine, and we have dozens of initiatives that use technology to increase efficiencies in the clinic pathway.
For example, in researching how we can avoid readmissions, we now start the surgical process sooner and involve the patient and family more through our pre-op clinic.
We now work with our patients to improve their health preoperatively so they have a better postoperative outcome. Rather than handing patients a list of instructions before their procedures, we ask them to sign a document committing to their role in their recovery, which includes bringing a family member or friend to appointments.
We are creating our culture from the ground up. Keck Medicine of USC is only 8 years old, so we have the advantage of being an academic startup. We're developing a new way to do academic medicine.
When patients come to us, they want a true team, not individual players. They want everyone to be fully invested in making them well again, from their first appointment and perhaps for the rest of their lives.
Going all-in on bundled payments, and the culture required to deliver it, will finally give our patients the all-star team they deserve.
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